Advanced Reproductive Specialists

03/01/2026

Endometriosis is TREATABLE!

Endometriosis is one of the most misunderstood (and mistreated) diseases in Gynecology and maybe medicine in general. The following discussion aims to explain our professional experience with this disease over the last 20 years where we took a special interest in the disease and its management. Our perspective is very different than what is conventionally believed.

Our surgical treatment method is complete excision that still, even today, is very unusual. There are few gynecologists in the US that do extensive excision surgery for endometriosis. The reasons for this relates very much to history and the advent of laparoscopic technology. From 1900 – 1975, all surgery for endometriosis was through an open incision like that for a hysterectomy. The treatment technique, though, was excision. There are numerous studies during that time period that showed 80+ % long term success for pain relief. This is compared to many laparoscopic cautery studies where long term relief is much less than 50%. There were also many studies that demonstrated an increase in fertility after excision treatment.

Recurrence: In contrast to what patients read on the internet, or told by physicians, endometriosis is most likely NOT a recurrent disease. We have re-operated on many patients in 18 years for other reasons with rare findings of recurrent disease. Most, >99% of gynecologists in the US, use destructive methods at surgery (cautery and laser) in an attempt to “destroy” visible lesions. In most cases, there are numerous lesions present, making this spot treatment very difficult. Microscopic lesions can be missed, and the tissue changes color with cautery and it is impossible to know if the entire lesion has been destroyed, especially for deeper lesions. With excision, the entire area including all the lesions extending out to normal peritoneum is removed. If lesions are deep, we recognize it as we undermine the peritoneum and can completely remove it. We believe a person gets all the endometriosis they are going to have by the mid teens and from there lesions go through their life-cycle and if removed are gone forever. No new disease is forming. What has been observed though by other physicians over time is recurrent pain in patients with endometriosis and when re-operated after a prior cautery procedure, lesions are seen. We see this also in nearly all patients after cautery and laser procedures and there is disease present but it is obvious that some of the disease has been treated before, just not completely. The appropriate word therefore is persistence not recurrence. We therefore feel that excision is curative for endometriosis. Pain could recur but endometriosis would be an unlikely cause of the problem. Hence pain does not equal endometriosis.

Adenomyosis: Endometrial cells located in the muscle wall of the uterus. All patients with endometriosis probably have some degree of adenomyosis. The pain with endometriosis is probably most often characterized as pain with periods in the teen years. As the lesions begin to burn out in the 20’s, many patients report cycles becoming less painful. By the mid 30’s, many patients are again having increased pain with periods. This however, is most likely due to the slowly progressive problem of adenomyosis. Therefore, after excision of endometriosis, if pain with periods recurs it is likely adenomyosis. Adenomyosis is not visible at or treated by surgery except through hysterectomy. It is most commonly suspected when the uterus is enlarged on ultrasound. Continuous birth control suppression can slow the progression of this process.

Call our office to schedule a consultation.

Advanced Reproductive Specialists
Jacksonville Center for Reproductive Medicine

02/28/2026

Occult or hidden Inguinal hernia as a cause of pelvic pain in women

Currently in the U.S., there are fewer than 5 programs considering or offering treatment for inguinal hernias as a cause of pelvic pain in women. These hernias are called hidden because they are not appreciated on exam, xray or even visible initially on laparoscopy. This is a clinical syndrome that is diagnosed solely based on history, with some findings on exam that relate to the location of pain. The diagnosis is confirmed with a special search or dissection into the inguinal region at laparoscopy and the treatment is administered at that time in the same way a traditional hernia is repaired. To further define this, while typical hernias are visible immediately at laparoscopy because of the prolapse of the peritoneum through the inguinal ring, with occult hernias, there is no prolapse of peritoneum in most cases and therefore would be “missed” in a standard laparoscopy. This is a large part of the confusion with this diagnosis.

Little research has been done or exists on this topic but the buzz words for the syndrome are “sports hernia” or “runner’s hernia.” Even so, less than 15 articles exist on this topic. Dr. Debra Metzger, a reproductive endocrinologist, was instrumental in developing this diagnosis and treatment approach back in the 1980’s and 90’s. She treated hundreds of patients with great success and promoted the procedure. Diagnosis and treatment of hernias, however, is done by general surgeons as an integral part of their specialty. The vast majority of General surgeons on a philisophical basis do not operate solely for pain without diagnostic findings. This certainly would be a prudent approach for traditional hernias where a bulge is usually appreciated. This approach though would exclude 90+ percent of the occult hernias that we see and treat. Gynecologists on the other hand have been operating for pain for over 100 years to diagnose and treat endometriosis. The idea of operating on pain without specific findings is therefore not at all foreign to us.
At ARS/JCRM, we have established a working relationship with some general surgeons who are open minded enough initially to work with us and now see the dramatic results in their patients. Other surgeons have been critical of the approach and universally would tell our patients that they do not have a hernia if the patient was evaluated by these physicians. This is not a criticism of them as surgeons, this is simply a very obscure description and we wouldn’t expect any physician to understand this without specific education. This syndrome is very common in association with endometriosis and about 30-40% of our pain surgeries include attention to this problem.

The History: Patients may report the following:
Lateral low quadrant pain (often, “my ovaries”) that is sharp and intermittent or constant

Radiates: Down the front of the leg / inner thigh / groin
Through or around to the back
Less commonly to the hip or up towards ribs
Pain is worse with in*******se, periods and with exercise or standing for a long time
The pain can be relieved by recumbent position
Often relieved some by pressing on the area
Generally worsens over time but may come and go.
A prior laparoscopy seems to be able to relieve this pain for 3-12months.
A common history is a patient who has had several laparoscopies for endometriosis followed by losing one o***y (the bad pain side) followed by hysterectomy only to continue with the same pain localized to the groin.
The Physical Exam:
Pain just above the crease of the leg to palpation.
Valsalva or straining can make the pain increase in some.
Pain on vaginal exam when directed toward the inguinal ring.
The exam findings are not subtle in the vast majority of cases.
*Few patients exhibit all of these symptoms. Most patients have several of these key elements.
Xrays: CT would almost never find this. MRI might see it in a minority of cases.

Dr. Michael Fox, MD
Advanced Reproductive Specialists
Jacksonville Center for Reproductive Medicine
www.JCRM.org

https://jcrm.org/occult-or-hidden-inguinal-hernia-as-a-cause-of-pelvic-pain-in-women/

Currently, in the U.S., there are fewer than five programs considering or offering treatment for inguinal hernias as a cause of pelvic pain in women. These hernias are called hidden because they are not appreciated on an exam, X-ray, or even visible initially on laparoscopy. This

02/24/2026

02/21/2026

Take a tour with Alex from our Macon, Georgia office.

02/19/2026

In 2020 after years of infertility and 4 miscarriages we found Advanced reproductive specialists! We live in Gainesville so it was so nice they have a clinic there. With my advanced age Dr Lipari was still so encouraging! I went through some medicated cycles and IUI's but ultimately we decided IVf would be best! Dr Lipari suggested endometriosis surgery that went so successfully! Dr Fox did our 2nd transfer and now we have our miracle girl! Jessica at the Gainesville clinic was such a blessing to us! Today Kare got to meet her and rock her Advanced Reproductive shirt!! We wouldn't have our miracle without everyone from the Gainesville and Jacksonville branch! Forever grateful! 💞

02/18/2026

Approximately 85% of couples achieve a pregnancy within one year of regular unprotected in*******se. This means about 12-15% of couples seek some form of fertility treatment at some point during their lifetime.

If you fall into any of these categories, call for an evaluation:

Women
• Age 35 and under who have been trying to conceive for 1 year without success
• Over the age of 35 who have been trying to conceive for 6 months without success
• Who have irregular periods or an absence of periods
• Who have other known problems that may affect fertility; ovulation problems, fibroids, endometriosis, blocked fallopian tubes, history of pelvic or abdominal surgeries or sexually transmitted infections

• Who have successfully become pregnant in the past, but are now unable to achieve a pregnancy

• Who have had multiple miscarriages

• Who desire to electively preserve their fertility

• Who know they will be having chemotherapy, radiation, an/or pelvic surgery due to a cancer diagnosis and want to preserve their fertility for the future

Men
• With an abnormal semen analysis

• With hormonal abnormalities; varicocele, a blockage, or absence of the duct that transports s***m from the duct, and/or difficulty with ej*******on

• Who have undergone a vasectomy

• Who know they will be having chemotherapy, radiation, and/or pelvic surgery due to a cancer diagnosis and want to preserve their fertility for the future

We understand how a diagnosis of subfertility is extremely anxiety provoking and stressful.
At ARS/JCRM, we have extensive experience, not only with diagnosing and the surgical/medical management of subfertility, but also in managing the stress that this diagnosis may bring. We take a comprehensive approach that provides a couple with all possible treatment options. You have a choice and it should be a well-informed and knowledgeable one, made only after understanding the underlying diagnosis and individualized fertility paths that are available to you.

Please call our office to schedule an appointment.

Should I See a Fertility Specialist? Approximately 85% of couples achieve a pregnancy within one year of regular unprotected in*******se. This means about 12-15% of couples seek some form of fertility treatment at some point during their lifetime. If you fall into any of these categories, call JCRM....

02/14/2026

She’s Daddy‘s Valentine for sure!
She received her first bouquet of flowers!💐
Happy Valentine’s Day!

02/14/2026

💘 Cupid here, spreading love and sparkles 🌟! Wishing you a Valentine's Day filled with joy, laughter, and all the cozy moments that make life sweet. ❤️ 😊

02/12/2026

Valentine's Day can be a tough day for those struggling with infertility. The flowers, the love stories, the baby bumps... it can feel like the world is celebrating something that's just out of reach 🙁.

If you're in this place, know that you're seen, you're loved, and you're not alone. Your journey is unique, and there's hope. Take care of yourself and make a plan- do something that brings you comfort, whether that's a quiet night in, a friend's listening ear, or a favorite hobby 💕.

You don't have to go through this alone.

02/09/2026

We are currently recruiting compassionate women who are willing to help infertile couples achieve their dreams of parenthood. Women interested in donating their eggs must pass our screening process, which includes drug, fertility, genetic, psychological, and STD testing.

Egg Donor Requirements:
* Women between the ages of 20 and 29
* Weight appropriate for their height (a BMI score >19 or

Become an Egg Donor Today We are currently recruiting compassionate women who are willing to help infertile couples achieve their dreams of parenthood. Women interested in donating their eggs must pass our screening process, which includes drug, fertility, genetic, psychological, and STD testing. Eg...

02/05/2026

Terri and her team get 5 star ⭐️ reviews consistently. Their passion and compassion is felt!

Here’s another great review!

I used Terri and her office for my outside monitoring for my surrogate journey from an IVF clinic in Colorado. I have never felt so taken care of. They were so accommodating! They were so nice and kind and just professional! I went through a missed miscarriage and then started getting monitored again after my second transfer and every one of the team members from the front desk to the sweet gal that draws blood to Courtney to Terri.. we’re just so so amazing! I will miss coming in and being so taken care of and I wish this office nothing but blessings and success. Thank you.

02/02/2026

From our Jacksonville office!

Our one and only embryo made her grand arrival on 1.28.26 at 10:34 PM

We are forever grateful to Dr. Lipari and the incredible team at Jacksonville Center for Reproductive Medicine for walking beside us with compassion, wisdom, and unwavering support, helping make something we once thought impossible our reality.

We are soaking up every baby snuggle.

-Chelsea & John Paulk